Pain relief vs. healing – A key distinction – But one that’s easy to miss when one is in urgent pursuit of relief and needs to get on with the necessities of life.

Braces and other supports DO seem to relieve pain, and it’s only natural to assume that if it’s feeling better it must be getting better. It must be healing – But is it? Will the brace help the injury HEAL?

Some physical therapists have taken up an unproven practice that looks like acupuncture.

TennisElbowClassroom's insight:

There is definitely a lot of debate - if not an outright turf war - over this question!

Some Acupuncturists, and their State boards, claim Dry Needling is a technique that falls entirely within their scope of practice and no others.

But, according to USA Today, the US Physical Therapy Association apparently advises members in at least seven states…

Including California, Florida, Hawaii, Idaho, New York, South Dakota and Washington to avoid using Dry Needling, because of recent regulatory decisions or language in existing Physical Therapy licensing laws.

The USA article also claims that most of the United States' 200,000 Physical Therapists have not been trained in Dry Needling, and only approx. 6,000 have taken courses in it.

I tend to think that if you're a P.T. with training in the technique, you should be allowed to practice it... What do you think?

The use of ice as a supplement to an exercise programme has been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined its effectiveness.To investigate whether an exercise programme supplemented with ice is mor

When you have an extremely stubborn, chronic case of Lateral Epicondylitis or Medial Epicondylitis (Tennis Elbow or Golfer's Elbow) And you've been struggling with for it months – Or maybe even for years – When should you realistically begin to consider surgery as a treatment option? And how do you know if you're a good candidate for a surgical procedure or not?

TennisElbowClassroom's insight:

Sure, surgery for Tennis Elbow may very well be a quick and "easy" procedure, but it's still surgery. The question is: How do you know when to throw in the towel on more conservative measures and decide it's time for surgery?

"The only difference observed between the groups was that patients who underwent the Nirschl procedure for Tennis Elbow [genuine surgery] had significantly more pain with activity at 2 weeks, when compared with sham surgery alone (p<0.05)"...

"Conclusion: This pilot study indicates that, in the short term, surgical excision of the degenerative portion of ECRB [the tendon most often associated with classic Tennis Elbow] confers no additional benefits to patients with chronic Tennis Elbow over and above a skin incision alone."

[So, basically, one group of people had an actual surgical procedure for Tennis Elbow, and one group had a fake / sham procedure, where the skin was cut open but nothing else was done - Obviously, the 2nd group didn't know they weren't getting a real surgery.]

[Both groups improved equally over time, so, since the people who got the "real" surgery didn't do any better that the people who got the fake surgery there isn't any proof that this type of surgery actually "works" - and the "benefits" could all be due to the placebo effect, which is one of the most powerful "drugs" known to man and medicine.]

Is Platelet-Rich Plasma (PRP) a breakthrough in Tennis Elbow treatment or an overpriced, hyped-up fad?

In this “podcast video” Allen Willette from Tennis Elbow Classroom, discusses the upsides and downsides of PRP, (an injection procedure that uses your own blood)...

Including whether it's a safe and effective treatment for Tennis and Golfer's Elbow; whether it's worth the price – and the pain afterward (also sometimes during) – and whether there are any alternatives to achieve the same goals.

"Equipment is used to deliver electrical current into the painful area over multiple sessions. Often a corticosteroid cream or patch or other medication is added and it is then pushed through the tissue with the electricity (this combination is known as Iontophoresis)."

TennisElbowClassroom's insight:

According to the Tennis Elbow Foundation, when it comes to the use of Electrical Muscle Stimulation - or 'Estim' for treatment:

"There is little to no medical evidence that this approach works for chronic Tennis Elbow."

"Further investigation and study is needed. Health insurance companies are now becoming hesitant to pay for this..."

Did anyone ever really think that zapping muscles with electricity and making them involuntarily twitch is going to help HEAL Tennis Elbow? ...

Or has it always been just another modality to take on to the Physical Therapy clinic's bill to the insurance company?

Lateral Epicondylitis (Tennis Elbow) Market Valued At USD 8,104.0 Mn In 2015, And Expected To Reach USD 10,582.1 Mn By 2022, Growing At A CAGR of 3.2% From 2016-2022

TennisElbowClassroom's insight:

Tennis Elbow is on the rise Globally - And people are spending a fortune on it! 8 Billion in 2015 and forecast to hit 10 BILLION by 2022! (Most of which apparently goes to Cortisone shots and anti-inflammatory pills, sadly = "Symptom Chasing")

This is not the first study showing good short-term benefits but poor long-term outcomes, calling into question this ubiquitous, "preferred first line of treatment among many orthopedic specialists...." according to "Recent surveys in the United States and Britain."

For a detailed look at Cortisone shots and Tennis Elbow, including references from and links to several other studies, see:

A leading Sydney surgeon has admitted to performing surgeries that don't work to appease patients. Professor Ian Harris notes that sometimes the only benefit from surgeries is the 'placebo effect'.

TennisElbowClassroom's insight:

"I have operated on people that didn't have anything wrong with them in the first place," writes Professor Harris, a Sydney Australia Orthopedic Surgeon, in his new book 'Surgery, The Ultimate Placebo.'

"This happens because if a patient complains enough to a surgeon, one of the easiest ways of satisfying them is to operate."

When it comes to surgery for Tennis Elbow, he writes, "Tennis Elbow is a condition that improves over time and surgery is not believed to be effective."

In a new book, Australian orthopedic surgeon Ian Harris argues that the evidence for the success for many common operations, including Tennis Elbow surgeries, knee arthroscopies, spinal fusions, epidural steroid injections and cardiac stenting procedures is no better than placebo and may actually cause more harm than good.

TennisElbowClassroom's insight:

Ian Harris, an Australian Orthopedic surgeon and Professor has confessed to performing surgery "that doesn't work" in response to pressure from patients and other factors.

In his new book, 'Surgery, The Ultimate Placebo' he writes:

"For many complaints and conditions, the real benefit from surgery is lower and the risks are higher than you or your surgeon think."

I admire this Doctor's honesty and willingness to utter what may be tantamount to medical heresy!

Recently, platelet-rich plasma is being used to treat tendon and cartilage injuries. A Dubai orthopaedic specialist talks about the experimental treatment that has risen in popularity after being used by elite athletes such as Rafael Nadal and Tiger Woods.

TennisElbowClassroom's insight:

Dr Harold Vanderschmidt, an Orthopedic Surgeon in Dubai, who has treated approx. 800 patients using PRP since 2012, reminds us that:

"The treatment is not a pain medicine... and, in fact, can result in more pain for up to two weeks after the injection."

(That's because PRP triggers a healing response, which is initiated by inflammation.)

Inflammation is the first stage of the healing process of injured tissue and there's no way around that.

But it sounds like this Surgeon has a high success rate with it, and most of his patients don't end up needing surgery.

Looks like he still believes in trying other methods before resorting to PRP though, and uses it:

"...only when the patient has tried different treatment models and they are not working."

Platelet-Rich Plasma (PRP) and the similar Autologous Blood Injection (ABI) appear to be a promising, new treatment approach to stubborn, chronic tendon injuries, like Golfer's Elbow and Tennis Elbow – But is that just the "hype" talking?

TennisElbowClassroom's insight:

A Storify compilation of the recent stories and studies on PRP and ABI in the last few years attempting to answer the challenging question of whether this promising, new treatment approach works.

Is it an effective treatment for stubborn, chronic tendon injuries like Tennis Elbow and Golfer's Elbow - Or is it all about the hype?...

And for a more detailed look, including my own take on it, see my latest post on PRP here:

They gave two groups of people with Tennis Elbow (a total of 44) two injections four weeks apart.

Half the people got injections of Platelet-Rich Plasma, half got saline injections (salt water.) Most people were pain-free after a year, but the people who got PRP did no better than people who got saline.

"...injections of growth factors-containing platelet-rich plasma are no more effective in treating recently developed epicondylitis than injections of saline."

"while PRP injections were shown to have no inherent benefit... what is exciting is that pain scores in both treatment groups decreased significantly over the course of the trial."

(The pain scores in the both groups had improved by about 50-60% at the 6-month mark.)

"The healing process is stimulated by the echo-guided injection of a substance and/or by the own effect of the needle (needling); the injections stimulate the process of tendon repair through an irritation effect, a technique known as Prolotherapy."

So this is not a negative or necessarily a confusing result, as the NPR story suggests . The study suggests that BOTH PRP and Prolotherapies (and/or dry needling/Fenestration) may be effective treatments.

(Although it's hard to separate the "Needle Effect" from the placebo effect, because any time they put a needle into a patients tendon - even if it's just as a control group and nothing is injected - you still have a potential benefit from the needle (again, the dry needling/Fenestration therapeutic effect.)

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